Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration.

作者: Ola G. Nilsson , Lennart Brandt , Urban Ungerstedt , Hans Säveland

DOI: 10.1097/00006123-199911000-00032

关键词: NeurologyBrain ischemiaIschemiaTranscranial DopplerMedicineAnesthesiaVasospasmIntensive careSubarachnoid hemorrhageMicrodialysis

摘要: OBJECTIVE: Intracerebral microdialysis has been demonstrated to be a useful method for detection of brain ischemia in experimental models and patients. We have applied new mobile microdialysate analysis equipment that allows bedside comparison changes neurochemistry with the neurological status patient. Ten patients severe aneurysmal subarachnoid hemorrhage (that is, high risk vasospasm subsequent ischemic deficits) were selected.METHODS: Microdialysis catheters inserted into temporal subfrontal cortex at end aneurysm surgery. Samples, collected hourly 4 11 days, analyzed immediately glucose, lactate, glycerol later pyruvate glutamate. The patients' was monitored constantly, daily recordings blood flow velocities performed using transcranial Doppler sonography.RESULTS: Concentrations measured substances varied widely. Individual analyses revealed uneventful clinical courses generally low stable levels different metabolites, those signs cerebral various patterns neurochemical changes. Lactate glutamate seemed sensitive markers impending ischemia, increased associated deficits. Obtaining data directly great advantage when relating values other findings.CONCLUSION: Bedside intracerebral monitoring delayed dramatic extracellular concentrations could correlated These findings emphasize potential neurosurgical intensive care (Less)

参考文章(31)
Hans Säveland, Jan Hillman, Lennart Brandt, Göran Edner, Karl-Erik Jakobsson, Göran Algers, Overall outcome in aneurysmal subarachnoid hemorrhage: A prospective study from neurosurgical units in Sweden during a 1-year period Journal of Neurosurgery. ,vol. 76, pp. 729- 734 ,(1992) , 10.3171/JNS.1992.76.5.0729
Atsuo Yoshino, David A. Hovda, Tatsuro Kawamata, Yoichi Katayama, Donald P. Becker, Dynamic changes in local cerebral glucose utilization following cerebral concussion in rats: evidence of a hyper- and subsequent hypometabolic state Brain Research. ,vol. 561, pp. 106- 119 ,(1991) , 10.1016/0006-8993(91)90755-K
Per Enblad, Johann Valtysson, Jesper Andersson, Anders Lilja, Sven Valind, Gunnar Antoni, Bengt Långström, Lars Hillered, Lennart Persson, Simultaneous Intracerebral Microdialysis and Positron Emission Tomography in the Detection of Ischemia in Patients with Subarachnoid Hemorrhage Journal of Cerebral Blood Flow and Metabolism. ,vol. 16, pp. 637- 644 ,(1996) , 10.1097/00004647-199607000-00014
Niklas Marklund, Konstantin Salci, Anders Lewén, Lars Hillered, Glycerol as a marker for post-traumatic membrane phospholipid degradation in rat brain. Neuroreport. ,vol. 8, pp. 1457- 1461 ,(1997) , 10.1097/00001756-199704140-00026
L. Hillered, L. Persson, U. Pont�n, U. Ungerstedt, Neurometabolic monitoring of the ischaemic human brain using microdialysis. Acta Neurochirurgica. ,vol. 102, pp. 91- 97 ,(1990) , 10.1007/BF01405420
B.A. Meyerson, B. Linderoth, H. Karlsson, U. Ungerstedt, Microdialysis in the human brain: extracellular measurements in the thalamus of parkinsonian patients. Life Sciences. ,vol. 46, pp. 301- 308 ,(1990) , 10.1016/0024-3205(90)90037-R
Hans Carlson, Elisabeth Ronne-Engström, Urban Ungerstedt, Lars Hillered, Seizure related elevations of extracellular amino acids in human focal epilepsy. Neuroscience Letters. ,vol. 140, pp. 30- 32 ,(1992) , 10.1016/0304-3940(92)90674-V
A. Mendelowitsch, L.N. Sekhar, D.C. Wright, A. Nadel, H. Miyashita, R. Richardson, M. Kent, A. Shuaib, An Increase in Extracellular Glutamate is a Sensitive Method of Detecting Ischaemic Neuronal Damage during Cranial Base and Cerebrovascular Surgery. An in Vivo Microdialysis Study Acta Neurochirurgica. ,vol. 140, pp. 349- 356 ,(1998) , 10.1007/S007010050108
Bo K. Siesjö, Pathophysiology and treatment of focal cerebral ischemia: Part I: Pathophysiology Journal of Neurosurgery. ,vol. 108, pp. 616- 631 ,(2008) , 10.3171/JNS/2008/108/3/0616